ÖZET
Amaç:
Multipl skleroz hastalarında pertürbasyon eğitiminin (PE) denge, yürüme ve lumbal stabilizasyon üzerine etkisini araştırmak.
Yöntemler:
On hastaya 6 hafta boyunca haftada iki kez manuel PE verildi. Statik denge için Romberg Test (RT), Keskinleştirilmiş Romberg (KR), Tek Bacak Duruş Testi (TBDT) yapıldı. Dinamik denge Fonksiyonel Uzanma Testi (FUT)’yle, Lateral Uzanma Testi (dominant, non-dominant; LUT-D, LUT-ND)’yle ve Dört Kare Adım Testi (DKAT)’yle değerlendirildi. Düşme korkusunu değerlendirmek için Düşme Etkinliği Skalası (DES) kullanıldı. Fonksiyonel mobilite ve lumbal stabilizasyonu değerlendirmek için sırasıyla Zamanlı Kalk ve Yürü (ZKY) testi, Basınçlı Biofeedback Stabilizer (BBS) kullanıldı.
Bulgular:
SR ve SLST sonuçları tedaviden sonra anlamlı olarak arttı (p<0,05). Ancak RT süresi için tedavi öncesi ve sonrası arasında fark yoktu (p>0,05). FUT ve LUT-ND değerleri arasında önemli fark vardı. Tedavi ile LUT-D ve DKAT sonuçları değişmedi. Tedavi sonrasında bireylerin düşme korkusu azalsa da, istatistiksel analize yansımadı (p>0,05). Tedaviden sonra ZKY süresinde iyileşmeler kaydedildi (p=0,01). Tedavi öncesi ve sonrası arasında BBS süresi bakımından fark yoktu (p>0,05).
Sonuç:
Bu çalışma, klinikte bilgisayarlı sistemler olmadan manuel PE’nin statik ve dinamik dengeyi, yürüyüşü, düşme korkusunu iyileştirebileceğini göstermiştir. Ayrıca çalışmamızda PE’nin multipl sklerozda lumbal stabilizasyon üzerine etkisi saptanmadı. Önemli sonuçlarımız küçük örneklem büyüklüğü ile sınırlıydı; ancak, gözlemlenen sonuçlar gelecekteki çalışmaların tasarlanmasına katkıda bulunabilir.
References
1
Campbell E, Coulter EH, Mattison PG, Miller L, McFadyen A, Paul L. Physiotherapy rehabilitation for people with progressive multiple sclerosis: a systematic review. Arch Phys Med Rehabil 2016;97:141-51.e3.
2
Learmonth YC, Ensari I, Motl RW. Physiotherapy and walking outcomes in adults with multiple sclerosis: systematic review and meta-analysis. Phys Ther Rev 2016;21:160-72.
3
LaRocca NG. Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners. Patient 2011;4:189-201.
4
Lanzetta D CD, Pellegatta D and Cardini R. Trunk control in unstable sitting posture during functional activities in healthy subjects and patients with multiple sclerosis. Arch Phys Med Rehabil 2004;85:279-83.
5
Fry DK, Huang M, Rodda BJ. Core muscle strength and endurance measures in ambulatory persons with multiple sclerosis: validity and reliability. Int J Rehabil Res 2015;38:206-12.
6
Amatya B, Khan F, Galea M. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019;1:CD012732.
7
Mansfield A, Aqui A, Centen A, Danells CJ, DePaul VG, Knorr S, et al. Perturbation training to promote safe independent mobility post-stroke: study protocol for a randomized controlled trial. BMC Neurol 2015;15:87.
8
Santos MJ, Kanekar N, Aruin AS. The role of anticipatory postural adjustments in compensatory control of posture: 2. Biomechanical analysis. J Electromyogr Kinesiol 2010;20:398-405.
9
Santos MJ, Kanekar N, Aruin AS. The role of anticipatory postural adjustments in compensatory control of posture: 1. Electromyographic analysis. J Electromyogr Kinesiol 2010;20:388-97.
10
Mehravar M, Yadollah-Pour N, Tajali S, Shaterzadeh-Yazdi M-J, Majdinasab NJJoMiM, Biology. The role of anticipatory postural adjustments and compensatory control of posture in balance control of patients with multiple sclerosis. J Mech Med Biol 2015;15:1550087.
11
Salcı Y, Karanfil E, Ayvat E, Balkan AF, Karakaya J, Aksoy S, et al. Investigation of Adaptation to Successive Postural Perturbations in Patients with Multiple Sclerosis. Turk J Neurol 2020;26:24-9.
12
Schinkel-Ivy A, Huntley AH, Aqui A, Mansfield A. Does Perturbation-Based Balance Training Improve Control of Reactive Stepping in Individuals with Chronic Stroke? J Stroke Cerebrovasc Dis 2019;28:935-43.
13
van Duijnhoven HJ, Roelofs J, den Boer JJ, Lem FC, Hofman R, van Bon GE, et al. Perturbation-based balance training to improve step quality in the chronic phase after stroke: a proof-of-concept study. Front Neurol 2018;9:980.
14
Tajali S, Rouhani M, Mehravar M, Negahban H, Sadati E, Oskouei AEJIjoMc. Effects of external perturbations on anticipatory and compensatory postural adjustments in patients with multiple sclerosis and a fall history. Int J MS Care 2018;20:164-72.
15
Massot C, Simoneau-Buessinger E, Agnani O, Donze C, Leteneur S. Anticipatory postural adjustment during gait initiation in multiple sclerosis patients: A systematic review. Gait Posture 2019;73:180-8.
16
Freeman J, Gear M, Pauli A, Cowan P, Finnigan C, Hunter H, et al. The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of single case studies. Mult Scler 2010;16:1377-84.
17
De Martino E, Salomoni SE, Winnard A, McCarty K, Lindsay K, Riazati S, et al. Hypogravity reduces trunk admittance and lumbar muscle activation in response to external perturbations. J Appl Psychol 2020;128:1044-55.
18
Nawasreh Z, Logerstedt D, Marmon A, Snyder-Mackler L. Clinical and Biomechanical Efficacies of Mechanical Perturbation Training After Anterior Cruciate Ligament Rupture. J Sport Rehabil 2019;28:877-86.
19
Lurie JD, Zagaria AB, Ellis L, Pidgeon D, Gill-Body KM, Burke C, et al. Surface Perturbation Training to Prevent Falls in Older Adults: A Highly Pragmatic, Randomized Controlled Trial. Phys Ther 2020;100:1153-62.
20
Mansfield A, Wong JS, Bryce J, Knorr S, Patterson KK. Does perturbationbased balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther 2015;95:700-9.
21
Cheng Y-S, Chien A, Lai D-M, Lee Y-Y, Cheng C-H, Wang S-F, et al. Perturbation-Based Balance Training in Postoperative Individuals with Degenerative Cervical Myelopathy: A Pilot Study. Front Bioeng Biotechnol 2020;8:108.
22
Aruin AS, Kanekar N, Lee YJ. Anticipatory and compensatory postural adjustments in individuals with multiple sclerosis in response to external perturbations. Neurosci Lett 2015;591:182-6.
23
Kumar C, Pathan N. Effectiveness of manual perturbation exercises in improving balance, function and mobility in stroke patients: a randomized controlled trial. J Nov Physiother 2016;6:2.
24
Khasnis A, Gokula R. Romberg’s test. Postgraduate Med 2003;49:169.
25
Widener GL, Allen DD, Gibson-Horn C. Randomized clinical trial of balance-based torso weighting for improving upright mobility in people with multiple sclerosis. Neurorehabil Neural Repair 2009;23:784-91.
26
Schuhfried O, Mittermaier C, Jovanovic T, Pieber K, Paternostro-Sluga T. Effects of whole-body vibration in patients with multiple sclerosis: a pilot study. Clin Rehabil 2005;19:834-42.
27
Galea MP, Cofré Lizama LE, Butzkueven H, Kilpatrick TJ. Gait and balance deterioration over a 12-month period in multiple sclerosis patients with EDSS scores≤ 3.0. NeuroRehabilitation 2017;40:277-84.
28
Ilett P, Lythgo N, Martin C, Brock K. Balance and gait in people with multiple sclerosis: a comparison with healthy controls and the immediate change after an intervention based on the Bobath concept. Physiother Res Int 2016;21:91-101.
29
Goh EY, Chua SY, Hong S-J, Ng SS. Reliability and concurrent validity of four square step test scores in subjects with chronic stroke: a pilot study. Arch Phys Med Rehabil 2013;94:1306-11.
30
Wagner JM, Norris RA, Van Dillen LR, Thomas FP, Naismith RT. Four Square Step Test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness. Int J Rehabil Res 2013;36:253-9.
31
Mitchell KD, Chen H, Silfies SP. Test-Retest Reliability, Validity, and Minimal Detectable Change of the Balance Evaluation Systems Test to Assess Balance in Persons with Multiple Sclerosis. Int J MS Care 2018;20:231-7.
32
Storheim K, Bø K, Pederstad O, Jahnsen R. Intra‐tester reproducibility of pressure biofeedback in measurement of transversus abdominis function. Physiother Res Int 2002;7:239-49.
33
van Vliet R, Hoang P, Lord S, Gandevia S, Delbaere KJAopm, rehabilitation. Falls efficacy scale-international: a cross-sectional validation in people with multiple sclerosis. Arch Phys Med Rehabil 2013;94:883-9.
34
Lurie JD, Zagaria AB, Pidgeon DM, Forman JL, Spratt KF. Pilot comparative effectiveness study of surface perturbation treadmill training to prevent falls in older adults. BMC Geriatr 2013;13:49.
35
Bertoni R, Jonsdottir J, Feys P, Lamers I, Cattaneo D. Modified Functional Walking Categories and participation in people with multiple sclerosis. Mult Scler Relat Disord 2018;26:11-8.
36
Morrison S, Rynders C, Sosnoff JJ. Deficits in medio-lateral balance control and the implications for falls in individuals with multiple sclerosis. Gait Posture 2016;49:148-54.
37
Cortesi M, Cattaneo D, Jonsdottir J. Effect of kinesio taping on standing balance in subjects with multiple sclerosis: A pilot study\m {1}. NeuroRehabilitation 2011;28:365-72.
38
Smania N, Corato E, Tinazzi M, Stanzani C, Fiaschi A, Girardi P, et al. Effect of Balance Training on Postural Instability in Patients With Idiopathic Parkinson’s Disease. Neurorehab Neural Repair 2010;24:826-34.
39
Mansfield A, Wong JS, Bryce J, Knorr S, Patterson KK. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther 2015;95:700-9.
40
Bhatt T, Yang F, Pai Y-C. Learning to resist gait-slip falls: long-term retention in community-dwelling older adults. Arch Phys Med Rehabil 2012;93:557-64.
41
Rosenblatt NJ MJ, Grabiner MD. Preventing trip-related falls by communitydwelling adults: a prospective study. J Am Geriatr Soc 2013;61:1629-31.
42
Mansfield A, Peters AL, Liu BA, Maki BE. Effect of a perturbation-based balance training program on compensatory stepping and grasping reactions in older adults: a randomized controlled trial. Phys Ther 2010;90:476-91.
43
Protas EJ, Mitchell K, Williams A, Qureshy H, Caroline K, Lai EC. Gait and step training to reduce falls in Parkinson’s disease. NeuroRehabilitation 2005;20:183-90.
44
Steib S, Klamroth S, Gaßner H, Pasluosta C, Eskofier B, Winkler J, et al. Perturbation during treadmill training improves dynamic balance and gait in Parkinson’s disease: a single-blind randomized controlled pilot trial. Neurorehab Neural Repair 2017;31:758-68.
45
Borghuis J, Hof AL, Lemmink KA. The importance of sensory-motor control in providing core stability. Sports Med 2008;38:893-916.
46
Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. J Electromyogr Kinesiol 2007;17:556-67.
47
Mueller J, Hadzic M, Mugele H, Stoll J, Mueller S, Mayer F. Effect of high-intensity perturbations during core-specific sensorimotor exercises on trunk muscle activation. J Biomech 2018;70:212-8.
